Chronic kidney disease and contemporary guideline-directed medical therapy during hospitalization in patients with heart failure: Insights from PRE-UPFRONT-HF.

Background: Chronic kidney disease (CKD) strongly affects prognosis in patients with heart failure (HF). However, the difference in the implementation of guideline-directed medical therapy (GDMT) during HF-related hospitalization between patients with and without CKD and its association with worsening heart failure (WHF) events remain unclear.

Methods: A post-hoc analysis was conducted using data from a retrospective, multicenter, observational registry of patients hospitalized for HF with a left ventricular ejection fraction (LVEF) of <50 %. The primary endpoint was a composite of outpatient WHF, HF-related hospitalization, and all-cause mortality.

Results: Of the 442 patients, 246 had CKD (56 %). These patients were older and had a higher prevalence of HF. At admission, the GDMT score was higher in patients with CKD than in those without CKD [3 (interquartile range, 1-5) vs. 1 (0-4)]; at discharge, the GDMT score was lower in patients with CKD [5 (3-7) vs. 6 (4.5-8)]. Optimized GDMT implementation at discharge, defined as a GDMT score of ≥6, was independently associated with improved prognosis in both groups.

Conclusions: In-hospital GDMT implementation was less optimized in patients with CKD compared with those without. Nevertheless, optimized GDMT implementation at discharge was associated with a lower incidence of adverse events, regardless of CKD status, among patients hospitalized with HF.